Potential Conflicts of Interest: Dr. Talal received research support from Merck/Schering-Plough and Genentech. He also served on speakers' bureaus for Genentech.

TO THE EDITOR:

Kanwal and colleagues (1) assessed the quality of care of patients with chronic HCV infection who were enrolled in a large health insurance plan. They compared various characteristics, including drug and alcohol use, to identify factors associated with quality HCV care.

The authors found that drug and alcohol use was not associated with receiving general HCV care (odds ratio [OR], 0.96 [95% CI, 0.88 to 1.04]) or with receiving any recommended care for HCV (OR, 1.01 [95% CI, 0.94 to 1.08]) (1). However, they discovered that drug and alcohol use was the strongest predictor of receiving higher-quality treatment of HCV (OR, 1.53 [95% CI, 1.34 to 1.74]) (1). It is hard to reconcile this apparent association with a large body of published data that has demonstrated that people who use illicit drugs are poorly engaged in evaluation for and treatment of HCV; for example, less than 10% of injection drug users with HCV who are referred for treatment actually initiate therapy (2, 3).